| NPI | 1780031393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101263434) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207P00000X Emergency Medicine (Licence: GU M-2424) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2024-04-10 |